(USA Herald) – In 2019, a New Year’s Eve sexual assault of a patient at a Miami hospital’s mental health ward made headlines around Florida. Fernando Felix Ramos-Garcia, a technician at Westchester General Hospital, was arrested three days later. The patient and her husband sued Westchester for over $50 million, alleging negligence and failure to adequately screen and supervise its staff. For three years, Westchester has argued that its liability policy applied, and Evanston Insurance Co. had a duty to defend the hospital in court. However, Evanston has argued that policy exclusions barred coverage.
Recently, Evanston lost its appeal to the 11th Circuit U.S. Court of Appeals, affirming the district court’s decision. The court ruled that “none of the relevant exclusions invoked by Evanston bars coverage for the Does’ claims against Westchester.” The court found that “services of a professional nature” and “professional services” are not identical but are not completely exclusive of each other. The court also found that the bodily injury exclusion language was open to interpretation and ambiguous, and that Florida courts have never before interpreted such wording.
This ruling is a victory for policyholders, ensuring that insurers cannot use “quirky” wording to deny coverage. The decision upholds the duty to defend the hospital in its litigation against the Does under the general liability coverage part. As a result, the umbrella policy also applies.
The case highlights the importance of ensuring adequate insurance coverage and reviewing policy language thoroughly to understand any exclusions or limitations. Policyholders should also seek legal advice to determine their rights and options when faced with coverage disputes.
This case has been closely followed by Samuel Lopez, an investigative journalist for USA Herald, who has been reporting on the case’s developments. The victim’s estate continues to pursue the case, and the outcome will have important implications for insurers and policyholders alike.
It is essential to hold insurers accountable and ensure they fulfill their obligations to policyholders. As this case shows, policyholders may face challenges when seeking coverage, but it is vital to fight for their rights and obtain the compensation they deserve. By upholding the duty to defend the hospital, the court has ensured that the policyholder will receive the coverage they need to defend themselves against claims of negligence and failure to supervise staff adequately.
In conclusion, Evanston’s loss in its appeal highlights the importance of ensuring adequate insurance coverage and reviewing policy language thoroughly. Policyholders should not let insurers use “quirky” wording to deny coverage and should seek legal advice when faced with coverage disputes. The ruling upholds the duty to defend the hospital, ensuring that insurers cannot avoid their obligations to policyholders. The case is a significant development in the ongoing fight for policyholders’ rights, and its outcome will have important implications for insurers and policyholders alike.
